Posts for: January, 2014

In modern times, metals have played an important role in tooth preservation and restoration. From the dental amalgam used for a century and a half to fill cavities to the titanium alloy of dental implants, your dental care would not be as comprehensive as it is today without them. But could these metals, so important in providing oral health, cause an allergic reaction in some people?

An allergy is an exaggerated response of the body’s immune system to any substance (living or non-living) it identifies as a threat. The response could be as minor as a rash or as life-threatening as a systemic shut-down of the body’s internal organs. An allergy can develop with anything, including metals, at any time.

A low percentage of the population has an allergy to one or more metals: some surveys indicate 17% of women and 3% of men are allergic to nickel, while even fewer are allergic to cobalt and chromium. Dermatitis patients seem to have a higher reaction rate, some allergic even to metals in jewelry or clothing that contact the skin.

Dental amalgam, an alloy made of various metals including mercury, has been used effectively since the mid-19th Century to fill cavities; even with today’s tooth-colored resin materials, amalgam is still used for many back teeth fillings. Over its history there have been only rare reports of allergic reactions, mainly localized rashes or moderate inflammation.

The most recent metal to come under scrutiny is titanium used in dental implants. Not only is it highly biocompatible with the human body, but titanium’s bone-loving (osteophilic) quality encourages bone growth around the implant’s titanium post inserted into the jawbone, strengthening it over time. But does titanium pose an allergic threat for some people? One study reviewed the cases of 1,500 implant patients for any evidence of a titanium allergy. The study found a very low occurrence (0.6%) of reactions.

The conclusion, then, is that the use of metals, especially for dental implants, carries only a minimal risk for allergic reactions and none are life-threatening. The vast majority of dental patients can benefit from the use of these metals to improve their oral health without adverse reaction.

Sometimes what’s going on in the mouth may point to a deeper issue. Although unpleasant to address, a dental examination could reveal signs of an eating disorder.

There are two disorders in particular that can adversely affect oral health: bulimia nervosa, characterized by food binging followed by purging through self-induced vomiting; and anorexia nervosa, characterized by self-starvation behavior. Occasionally, patients with one disorder may display behavior associated with another disorder.

“Binge-purge” behavior patterns are especially damaging to tooth enamel. When teeth are exposed to high levels of acid, the minerals in tooth enamel soften and erode. This is common with patients who overuse sodas, sports drinks and juices with high levels of citric acid. But bulimic patients also experience it because of stomach acid residue in the mouth after purging.

Patients with eating disorders also encounter other problems in the mouth. The salivary glands may become enlarged, giving the sides of the face a puffy appearance. The throat, palate and back of the tongue may appear red and damaged caused by fingers or other objects used to induce gagging.

There are also some differences between the two disorders in their effect on dental health. Anorexics tend to neglect grooming habits, including daily oral hygiene, which can lead to tooth decay and gum disease. Bulimic patients, on the other hand, are very mindful of body image and practice excellent grooming habits — but to a fault. In fact, aggressive brushing (especially after purging when high acid has caused enamel softening) can actually cause more erosion.

In the short-term, it’s important to treat dental problems caused by eating disorder behaviors, as well as encouraging better hygiene practices like waiting a few minutes to brush after purging or by rinsing with a little baking soda and water to help neutralize the acid. Ultimately, though, the eating disorder itself needs to be addressed and treated. In addition to your personal healthcare providers, the National Eating Disorders Association (nationaleatingdisorders.org) is a good online source for information and referrals.

Although a sensitive issue, an eating disorder can’t be ignored. Because of its effect on all aspects of health, including the teeth and mouth, the sooner it’s addressed, the better the outcome for patients and their families.

They work hard, and put in lots of time on the field and at home. They learn the rules of the game — as well as the unwritten rules of sportsmanship and teamwork. They receive the proper training, and wear appropriate protective equipment. But sometimes, in spite of everything, kids who participate in sports can be subject to injury. Fortunately, in today's dentistry there are a variety of treatments, as well as preventive measures, which can help.

When faced with serious dental injury, time is of the essence in saving teeth. So, don't delay — come in to see us immediately! If treated promptly, it's possible for teeth which have been dislodged — or even knocked out of the mouth — to be put back in position and stabilized. Afterwards, follow-up treatment will ensure that the tooth has the best chance of recovery.

The treatment of kids' dental injuries is sometimes different than that of adults. For example, in adults, a root canal would generally be necessary, followed by a tooth restoration (crown). But some kids may not need this treatment, since their teeth are still developing. Also, replacing a missing primary (baby) tooth may not be recommended, since it may hinder development of the permanent teeth. Based on his or her individual circumstances, we can develop an appropriate treatment plan for your child.

Luckily, the most common dental injuries aren't nearly as serious — they typically involve chipped or cracked teeth. Most can be repaired by reattaching the broken piece, or using a tooth-colored restoration. If a large part of the structure of a permanent tooth is missing, a crown or “cap” may be placed on the visible part, above the gum line. Smaller chips, even in primary teeth, can be successfully repaired by cosmetic bonding with composite resin materials.

Finally, if your child is involved in athletic activities — or if you are — consider obtaining a custom-made mouthguard. Numerous studies have shown that this protective gear can help prevent many dental injuries. Unlike the off-the-shelf types found in some sporting-goods stores, the ones we provide are individually fabricated from an exact model of the teeth. They're strong, fit comfortably, and offer superior protection at a reasonable cost.

There’s no doubt dental implants are an effective choice for restoring both the form and function of missing teeth. But although they aren’t susceptible to tooth decay as with natural teeth, the bone and gum tissues that surround them are. Implants, therefore, require the same cleaning and maintenance as natural teeth.

A dental implant is actually a root replacement, a titanium post surgically imbedded in the jawbone. Because titanium is osteophilic (“bone-loving”), bone will naturally grow around it, making the implant more secure over time. Atop the implant is an abutment to which an artificial crown, the visible portion of the implant, is attached. The abutment is surrounded and supported by connective fibers within the gum tissue that hold the tissue against the implant surface.

This attachment differs significantly from natural teeth’s attachment to the jawbone, which attach to a tooth’s root through the periodontal ligament. The tiny fibers of the ligament hold teeth in place; its elasticity allows for tiny adjustments in a tooth’s position in response to changes in other teeth and bone. The ligament is also rich in blood supply that enriches the area with nutrients and provides resources to fight and resist infection.

An implant doesn’t have this same degree of defense against infection. Without proper hygiene, a layer of bacterial plaque known as biofilm can develop on the crown surface of both natural teeth and restorations. In addition, an infectious condition specific to implants known as peri-implantitis can set in the gum tissues surrounding the implant. This can lead to bone loss (sometimes very rapid) and eventual loss of the implant.

Although your daily hygiene won’t require special toothbrushes or other devices for implant cleaning, your professional cleanings will. The metal instruments (known as curettes) used to clean natural teeth could damage implant surfaces. The hygienist will use devices made of plastic or resin rather than metal, and nylon or plastic sheaths or tips on ultrasonic equipment that are specially designed for implant cleaning.

While maintaining dental implants requires diligence on both your part and ours, implants remain an effective, long-term choice for dental restoration. In fact, some studies indicate upwards of 95% success rate. Proper hygiene will greatly increase your chances for many years of service from your implants.